JORGE E KOSTIANOVSKY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036045955

License Status

NOT RENEWED

Business

First Name

JORGE E

Last Name

KOSTIANOVSKY

Suffix

Business Name

JORGE E KOSTIANOVSKY MD

Original Issue Date

07/31/1972

Effective Date

07/31/1972

City

CLAYTON ST. LOUIS

State

Zip

63105

County

MISSOURI

Ever Disciplined

LastModifiedDate

09/20/2006